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pt momints ver 2.0 > Org Ana: The Thoracic Wall > Flashcards

Org Ana: The Thoracic Wall Flashcards

1
Q

what comprises the exterior of the thoracic wall

A

covered by skin and muscles of the shoulder girdle

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2
Q

where is the thorax located

A

at the region between the head, neck and abdomen

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3
Q

what comprises the inner surface of the thoracic wall

A

lined by parietal pleura

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4
Q

what is the thoracic cage

A

bony framework or the thoracic region’s wall

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5
Q

describe the shape of the thorax

A

flat in front and at the back but rounded on the sides bc of the angulation of the ribs

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6
Q

what are the boundaries of the thoracic cage

A

anterior - sternum and costal cartilages
posterior - T1-T12
laterally - ribs and intercostal spaces
superiorly - w neck
inferiorly - diapraghm

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7
Q

what is the superior thoracic aperture

A

bordered by T1, rib 1 and manubrium

structures from the head and neck passes as it goes down

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8
Q

what is the inferior thoracic aperture

A

bordered by T12, rib 12 and rib 11, costal margin and xiphoid process

structures from thoracic to abdomen pass here

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9
Q

what are the functions of the thoracic wall

A

protects heart and lungs
conduit for passing structures from head to abdomen
role in breathing
supports UE
attachment of muscles

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10
Q

what are the lines of orientation in anterior view from lateral to medial

A

anterior axillary
midclavicular
midsternal

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11
Q

what are the lines of orientation in lateral view from posterior to anterior

A

posterior axillary
midaxillary
anterior axillary

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12
Q

what are the lines of orientation in posterior view from lateral to medial

A

scapular
vertebral

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13
Q

what are the spaces in anterior view from superior to inferior

A

supraclavicular
infraclavicular
precardiac
traubes

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14
Q

what are the spaces in posterior view from superior to inferior

A

suprascapular - T2
interscapular - T3
infrascapular - T7

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15
Q

describe the pleuras of the thoracic cavity from most superficial to deep

A

parietal - inner surface of chest wall
pleural cavity - space bet
visceral - lines the lungs

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16
Q

what are the 3 parts of the sternum

A

manubrium
body
xiphoid

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17
Q

what is the articulations of the manubrium

A

w/ clavicle - clavicular notch
w/ first nd upper parts of second costal cartilages - 1st costal notch
w/ body - manubriosternal joint

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18
Q

what level is the jugular notch

A

T2

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19
Q

what is the level of manubrium

A

T3-4

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20
Q

at what level is the manubriosternal joint located

A

sternal angle of louie - T4-5

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21
Q

where does the body of sternum articulate

A

2nd-7th costal cartilages - ribs 8-10 w/ rib 7
w/ manubrium - manibriosternal
w/ xiphoid - xiphisternal

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22
Q

describe the xiphoid

A

hyaline cartilage that ossifies at proximal end in adults

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23
Q

what are the articulations of the xiphoid process

A

no ribs or costal cartilage
7th costal cartilage may have along w/ body
w/ body - xiphisternal
inferior end - attachment for line alba

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24
Q

at what level can the xiphisternal joint be found

A

opposite T9

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25
what is the significance of the sternal angle of louis
ribs are counted here - 2nd rib @ sternal angle separates sup nd inf mediastinum asc aorta ends, where arch is, desc aorta begins trachea divides into bronchi azygous vein arches over right lung into SVC pulmonary trunk divides into pulmonary arteries thoracic duct reaches left side here upper limit of base of heart cardiac plexus
26
what are the types of ribs
TRUE - first 7 - connected to sternum FALSE - 8-10 - attaches to rib 7 by costal cartilages - forms costal margin FLOATING - 11-12 - no attachment to sternum - costal cartilage embed to muscles at abdomen
27
what are the articulations of the head of a typical rib
sup - inferior costal facet of vertebra above inf - articulates w the superior costal facet of its vertebrae
28
describe the typical rib
long, twisted and flat sup border - round and smooth inf border - sharp nd thin w costal groove ant attaches to costal cartilage
29
describe the neck
separates head from tubercle
30
describe the head
posterior vertebral end
31
compare articular nd non articular parts of the tubercle
articular - articulates w numerically corresponding vertebra non articular - attachment of ligament
32
describe the shaft
long, thin, flat and twisted on long axis from tubercle to sternal end
33
describe the costal groove
elongated depression found in the inferior internal surface of the shaft of rib; holds intercostal vessels and nerve.
34
describe the angle
where body sharply turns from a lateral to a more anteriorly directed orientation; slightly distal to the tubercle
35
describe the sternal end
flat and has a depression for the costal cartilage
36
describe the first rib
small, flattened from above downward; thick attached only to T1 body; has a facet in the tubercle to articulate to the transverse process; 1 attachment only scalene tubercle (superior surface) which separates two smooth grooves crossing the rib at the shaft
37
describe the subclavian groove of the first rib
Anterior groove (subclavian vein) Posterior groove where lower trunk of brachial plexus (between clavicle and rib 1) and subclavian artery cross the rib and lie in contact with the bone
38
describe the second rib
Flat but twice as long as first rib; thicker than usual Articulates with the vertebral column in a way typical of most ribs
39
describe the tenth rib
Head of rib 10 has a single facet for articulation with own vertebra; no other articulation to T9
40
describe ribs 11 nd 12
articulates only with the bodies of their own vertebrae; have no tubercles or necks; both are short, little curve and are pointed anteriorly; has sternal end w costal cartilage embed to abdomen
41
what are costal cartilages
Hyaline cartilage connecting the upper seven ribs to the lateral edge of sternum and the 8th to 10th ribs to the cartilage immediately above
42
what is the function of costal cartilages
helps elasticity of thoracic wall - ribs expand n old age, it tends to lose some of its flexibility as the result of superficial calcification attaches rib to sternum
43
what are costal facets
demifacets - articular surface on the posterolateral aspect of the body at the junction of body and pedicle; located in superior and inferior sides;
44
compare sup nd inf demifacets
Superior articular facet faces posterolateral and inferior articular facet faces anteromedial
45
describe T1
a full costal facet for the head of 1 strib and inferior demifacet for the superior half of the head of the second rib
46
describe T11-12
costal facets (located mainly on the pedicles) instead of demifacets because the heads of ribs 11 & 12 articulate only with their own individual vertebrae
47
what are transverse costal facets
for articulation of the tubercle of the rib on the transverse processes; absent in T11 and T12
48
describe the movement of the sternal joint
small amount of angular movement during respiration
49
what is the landmarks for the sternal joint
opposite T4 attachment of 2nd costal cartilage plane of separation bet sup nd inf mediastinum
50
what type of joint is the sternal joint
cartilaginous
51
what type of joint is the costovertebral
synovial plane
52
which ribs have single synovial joints
1, 10, 11, 12
53
which ribs have 2 synovial joints
2-9
54
what connects the head of a rib to the IV disc
intra-articular lig
55
what type of joint is the tubercle to transverse process
synovial pane absent in 11-12 bc no tubercle
56
what type of joint is the rib to costal cartilage
cartilaginous - no movement
57
describe the joints betw costal cartilage and sternum
1st rib to manubrium - cartilaginous = no movement 2nd to 7th - synovial plane - lateral border of sternum 6th - 10th - synovial plane - cc articulates w one another
58
what type of joint is the manubriosternal
cartilaginous
59
what type of joint is the xiphisternal
cartilaginous
60
explain the significance of the 1st rib and the 12th rib during respiration
1st rib raises ribs during inspiration 12th rib pulls ribs down during expiration
61
what are the structures that pass through the thoracic outlet
esophagus trachea vessels and nerves apices of the lungs and pleura
62
what is the thoracic outlet syndrome
compression of brachial plexus or the subclavian vein/artery as it exits rib 1 and clavicle
63
what are the vascular symptoms of thoracic outlet syndrome
swelling/puffy hands cyanotic hands heaviness of arm pulsating lump above clavicle - weak radial pulse tooth ache like pain at neck and shoulder - inc at night easily fatigued arms superficial vein distention in hand
64
what are the neurologic symptoms of thoracic outlet syndrome
paresthesia at C8 and T1 dermatomes - inside forearm and palm C8: closing and opening of palms T1: add nd abd of fingers muscle weakness nd atrophy in gripping difficulty in fine motor tasks cramps of inner forearm pain tingling and numbness
65
what is the cause of thoracic outlet syndrome
cervical rib - extra rib at C7 = higher chance of pinch scalene syndrome - pinch bet movement of ant and middle scalene costoclavicular syndrome - bet clavicle and rib 1 hyperabduction syndrome -hyper abd of shoulder like backpack may pinch in betw rib 1 and clavicle
66
how to test for thoracic outlet syndrome
allen - elbow at panatang makabayan nd head pointed away - radial pulse dissapears as head rotates = + adsons - UE in abd, extension and ER - head towars involved side - diminished radial pulse = + costoclavicular maneuver - exaggerated attention posture - absence of pulse = + done if complains of pain during back pack etc
67
what is an intercostal space
space bet ribs where costal groove lies - intercostal nerves, arteries and vein
68
what are the layers of the thoracic wall from superficial to deep
skin superficial fascia deep fascia intercostal membrane endothoracic fascia extrapleural fatty layer parietal pleura
69
compare the intercostal muscles
external - most superficial down nd forward internal - intermediate down nd back innermost - deepest straight arrangement relates to endothoracic fascia nd parietal pleura
70
what fixes the first rib
scaleni muscle
71
what fixes the 12th rib
quadratus lumborum and oblique muscles
72
relate intercostals to respiration
external - elevates internal - depresses strength prevents sucking in or blowing out of lungs during changes in psi
73
what are the 3 parts of the diaphragm
sternal - from posterior surface of xiphoid costal part - from deep surface of lower six ribs nd cc vertebral - from the VC (crura) and arcuate ligaments
74
compare left nd right crus
left - from L1-2 right - L1-3
75
compare the medial and lateral arcuate ligaments
medial - side of L2 body to transverse process of L1 lateral - transverse process of L1 to lower border of 12th rib
76
what is the central tendon
muscle fibers of diaphragm that converge in the center at T9 sup surface partially fused w pericardium acts as a sphincter to prevent regurgitation of stomach contents
77
compare left nd right diaphragm
r - reaches upper border of rib 5 l - reaches lower border of rib 5 right is higher bc liver pushes it up
78
relate the levels of the diaphragm in diff positions
sitting/standing - lower supine/after meal - higher
78
what are the openings of the diaphragm
caval - T8 in the central tendon inf vena cava and right phrenic nerve esaphogeal - T10 in muscles from right crus esophagus vagus nerve left gastric vessel lymphatics aortic - T12 bet crura - gap behind posterior margin aorta thoracic duct azygos vein thoracic aorta becomes abdominal aorta
78
what passes at the crura
greater, lesser and lowest sympathetic splanchnic nerves
79
what passes medial arcuate ligament
sympathetic trunk passes posterior
80
what passes betw sternal and costal margin
superior epigastric vessel
81
what passes at the left dome
left phrenic nerve
82
arterial supp of diaphragm
pericardiophrenic and musculophreninc arteries - from internal thoracic art superior phrenic (thoracic) and inferior phrenic (abdominal)
83
venous supp of diapraghm
drains to brachiocephalic, azygos/abdominal veins
84
where does intercostal nerves come from
anterior rami of spinal nerves T1-11 T12 is subcostal nerve
85
describe the passage of intercostal nerves
first six - distributed w/in their intercostal spaces seventh to ninth - leave anterior ends of their intercostal spaces by passing deep to cc to enter the abdominal wall 10-11 = pass directly to abdominal wall
86
what does intercostal nerves carry
somatic motor intervention to muscles of thoracic wall sensor innervation skin and parietal pleura postganglionic sympathetic fibers to periphery, autonomic anterior ramus of T1 forms part of brachial plexus lat cutaneous branch of 2nd intercostal - sensory of upper arm lower intercostal supplies muscle, skin nd peritoneoum of abdominal wall
87
whats the arterial supp of thoracic wall
subclavian - sup intercostal nd internal thoracic axillary - sup nd lateral thoracic thoracic aorta - posterior intercostal and subcostal ant intercostal from lat thoracic - branch to 12 arteries to the ribs
88
what is the venous drainage of thoracic wall
right - superior intercostal azygos left - superior thoracic brachiocephalic veins

pt momints ver 2.0 (14 decks)

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